Stop TB Partnership Consultation – Global Fund Strategy Discussion September 2, 2015 Buenos Aires, Argentina Emanuele Capobianco, Senior Policy Advisor, The Global Fund
Content 1. Current Strategy and upcoming challenges 2. August 2015 Revised Strategic Framework 1
Content 1. Current Strategy and upcoming challenges 2. June 2015 Revised Strategic Framework 2
Strategy Framework 2012- 2016: “Investing for impact” 1/2 3
Strategy Framework 2012- 2016: “Investing for impact” 2/2 Strategic Objectives 1. Invest more 2. Evolve the 3. Actively support grant strategically funding model implementation success 1.1 Focus on the highest-impact countries, 2.1 Replace the rounds system with a more 3.1 Actively manage grants based on interventions and populations while keeping flexible and effective model impact, value for money and risk the Global Fund global • Iterative, dialogue-based application 3.2 Enhance the quality and efficiency of • Early preparation of implementation Strategic Actions 1.2 Fund based on quality national strategies grant implementation • More flexible, predictable funding and through national systems 3.3 Make partnerships work to improve opportunities 1.3 Maximize the impact of Global Fund grant implementation investments on strengthening health systems 2.2 Facilitate the strategic refocusing of existing investments 1.4 Maximize the impact of Global Fund investments on improving the health of mothers and children 4.1 Ensure that the Global Fund does not support 5.1 Increase the sustainability of Global Fund- 4. Promote supported programs programs that infringe human rights 5. Sustain the and 4.2 Increase investments in programs that 5.2 Attract additional funding from current and gains, protect address human rights-related barriers to access new sources mobilize human 4.3 Integrate human rights considerations resources rights throughout the grant cycle Enhance partnerships to deliver results Strategic Enablers Transform to improve Global Fund governance, operations and fiduciary controls 4
Decrease in HIV/AIDS Example: HIV in adolescent girls and young women New infections and deaths (2001-2015) HIV is the leading cause of death and disease among girls and women of reproductive age (15-49 years) worldwide. HIV incidence and prevalence among adolescent girls and young women is several times higher than their male peers HIV prevalence among young people – 15-24 select Sub-Saharan countries 18 Females 15-24 16 Males 15-24 14 12 10 8 6 4 2 0 5
Decrease in malaria Example: Risk of Malaria Resurgence Mortality (2000-2015) 6
Decrease in tuberculosis Example: Multidrug-resistant tuberculosis (MDR-TB) Incidence and mortality (1990-2015) Percentage of new TB cases with MDR-TB (latest year available) 7
Challenge: Key affected populations – TB • People living with HIV are from 26-31 times more likely to develop TB than persons without HIV. TB is the most common presenting illness among people living with HIV, including among those taking antiretroviral treatment and it is the major cause of HIV-related death • The level of TB in prisons has been reported to be up to 100 times higher than that of the civilian population. High levels of MDR-TB have been reported from some prisons with up to 24% of TB cases suffering from MDR forms of the disease • Refugees, prisoners, miners and other vulnerable populations face the highest risks. 8
Global Fund contribution to International Financing TB HIV Malaria 22% 28% 50% 50% 72% 78% Global Fund Global Fund Global Fund Other International Contributors Other Agencies (PEPFAR, World Other International Contributors Bank, Other Bilateral Agencies) Source : UNAIDS report on the global AIDS epidemic 2013, Global Tuberculosis report 2013, World Malaria report 2013 9
Total resources in the fight against the three diseases HIV TB Malaria 11% 13% 18% 5% 41% 50% 39% 41% 83% Global Fund Global Fund Global Fund Other International Contributors PMI and other International Other international contributors (PEPFAR, Contributors Domestic resources World Bank, Other Bilateral Agencies) Domestic resources Domestic resources Source : UNAIDS report on the global AIDS epidemic 2013, Global Tuberculosis report 2013, World Malaria report 2013 10
Challenge: Majority of disease burden in MICs HIV TB Malaria [m people, % of total 1) ] [m cases, % of total] [m cases, % of total] 12.1 Thereof MDR-TB 107 (34%) 4.2 (52%) 94 (48%) 10.1 9.8 (46%) (29%) (28%) 2.1 2.1 (24%) (24%) 5 (2%) Low Lower Upper Low Lower Upper Low Lower Upper Middle Middle Middle Middle Middle Middle 1) Total global HIV estimate: 35.3 m Notes: UNAIDS data, WHO 2012 data, Global Fund analysis – Results are indicative only and should not be used outside Global Fund bodies without prior consent. 11
Fragile states Domestic revenues in fragile states vs. other developing Disease burden and Global Fund allocation economies Fragile states Other countries 17% 7000 23% Overall 6000 Government Revenue, 2005 USD Bn 83% 77% 5000 4000 Disease burden Global Fund allocation 3000 Emerging market and developing economies 2000 ex-Fragile States 15% 23% Fragile States 25% Example: 32% 1000 TB 85% 0 77% 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Source: adapted from IMF World Economic Outlook, April 2014 and OECD fragile states classification Notes: Based on disease burden data used in 2014-16 allocation 12
Key aspects of the changing landscape from Development Continuum and Consultations • Progress against three diseases but potential for backsliding on HIV and malaria limited declines in incidence for TB and challenges of MDR-TB; • Many countries are growing economically but GDP is an imperfect predictor of ability to finance effective health interventions and addressing concentrated epidemics in MICs is a critical component of global progress; • Increasing domestic resources creates opportunities but often not targeted at KAPs, role for continued GF support for KAPs and human rights; • Challenging operating environments are growing component of LICs and malaria burden, require flexible approaches for impact • Importance of clearly defining GF role in building resilient and sustainable systems for health a top priority for countries and post-Ebola, plus role of communities; • Under any plausible replenishment and Secretariat staffing scenarios, strong need to further focus resources and tailor processes according to country context to ensure impact against diseases. 13
Key TB considerations for the next Global Fund Strategy • Alignment with WHO End TB Strategy and the Global Plan of the Stop TB Partnership • Paradigm shift: from “controlling TB” to “ending TB” • New prevalence surveys in some countries indicate higher disease burden than previously reported • 70% of the TB burden is in Middle Income Countries, including BRICS • New diagnostic tests, new drugs, regimens and combinations , are likely to be approved for use in the field for both drug-sensitive and resistant TB and for prevention among PLHIV. • Resource needs and replenishment 14
Content 1. Current Strategy and upcoming challenges 2. August 2015 Revised Strategic Framework 15
Draft August 2015 Strategic Framework: vision and mission Vision Current Text: “A world free of the burden of HIV/AIDS, tuberculosis and malaria with better health for all .” No revision. Mission Current Text: “ To attract, manage and disburse additional resources to make a sustainable and significant contribution in the fight against AIDS, tuberculosis and malaria in countries in need, and contributing to poverty reduction as part of the MDGs .” Suggested Revision: • “ Attracting, leveraging and investing additional resources to end HIV, tuberculosis and malaria as epidemics and to support attainment of the SDGs.” 16
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